Manager, Payor Operations

About the Role

Happy Sleep is looking for a Manager of Payor Operations to lead our credentialing and payor operations function — with a primary mandate to secure national payor agreements that let Happy Sleep operate at scale across markets. You'll manage a Credentialing Specialist who handles day-to-day credentialing execution, while you focus on the strategic relationships, contracting, and negotiation work that gets Happy Sleep in-network nationally rather than payor-by-payor, state-by-state.

You'll be the connective tissue between clinical operations, revenue cycle, and insurance payors — making sure nothing falls through the cracks that could delay a provider's ability to bill or a patient's ability to be seen, while also driving the bigger swing: converting a patchwork of regional payor relationships into durable, national agreements.

This role is a strong fit for someone who has run credentialing/payor ops hands-on, has direct experience negotiating with national payors, and is energized by moving between "in the weeds" problem-solving and high-stakes payor relationship management. You'll report to VP of Finance and will have significant latitude to shape how this function is built.

What You'll Do

National Payor Agreements

• Lead the strategy and execution to move Happy Sleep from state-by-state, payor-by-payor enrollment toward national in-network agreements with major commercial payors

• Build and pitch the business case for national contracting to payor leadership — data on volume, quality, cost savings, and network adequacy and, most importantly, health outcomes

• Own negotiations (or partner closely with Legal/Finance on) rates, terms, and effective dates for national agreements

• Sequence and prioritize which payors to pursue first based on member volume, existing patient overlap, and strategic fit

• Given Happy’s model, some payers gravitate toward a vendor or bundled arrangement with a path to a value based, shared savings model. You’re prepared to embrace this nuance and get it across the finish line

• Track and report progress on national agreement pursuit to executive leadership, including risks, blockers, and timeline

• Once agreements are signed, ensure smooth operational rollout — timely provider data load, fee schedule loading, updated payer directory and internal communication so billing/RCM can execute cleanly

Team Leadership

• Directly manage a Credentialing Specialist, providing day-to-day guidance, workload prioritization, and professional development

• Set clear SLAs and KPIs for credentialing turnaround time, clean application assembly , and renewal compliance, and coach the team to hit them

• Step in on complex or escalated credentialing/enrollment cases as needed

• Aid in forming responses to network managers that foster relationship building

• Continuously improve the systems, workflows, and tooling that support credentialing and payor enrollment (we currently use Modio as our PDM) )

Credentialing Oversight

• Ensure CAQH profiles, NPI records, state licenses, DEA registrations, are current, with proactive renewal tracking

• Ensure credentialing applications to commercial payors, Medicare, and Medicaid are submitted accurately and followed through to completion

• Maintain an accurate, real-time credentialing tracker/CRM across every provider and payor, with escalation paths for at-risk timelines (you can use Modio for this or build a tracker)

• Ensure re-credentialing requests are met in a timely manner

Payor Enrollment & Contracting Support

• Oversee payor enrollment for new markets and new provider onboarding, including Medicare PECOS and state Medicaid portals

• Partner with Legal/Contracting on payor contract loading, fee schedule validation, and effective-date tracking

• Manage escalated relationships with payor provider relations reps to resolve enrollment holds, revalidation requests, and demographic disputes

Payor Operations

• Own resolution of claim denial trends tied to credentialing or enrollment issues (e.g., "provider not on file"), driving root-cause fixes with RCM and Clinical Ops

• Ensure claims are held/released appropriately based on credentialing status, minimizing both compliance risk and delayed revenue

• Monitor payor policy changes (prior auth requirements, DME/sleep study coverage criteria, telehealth coverage rules) and translate them into operational and process changes

• Own reporting and forecasting on credentialing turnaround time, enrollment status by payor/state, and revenue at risk from credentialing gaps — presented to executive leadership

Cross-Functional Collaboration

• Partner with Clinical Ops leadership to align provider onboarding and hiring plans with credentialing lead times and national agreement rollouts

• Serve as the organization's subject-matter expert and executive-facing voice on payor requirements and national contracting strategy for sleep medicine and DME billing